Managing poor performance

Managing poor performance in clinical placements and the issues and challenges with result

Poor performance in clinical placements: issues and challenges
  • how much of an issue is poor performance?
  • identifying poorly performing students
  • managing the placement process
  • failure to fail and borderline assessments.
Why is poor performance on placement an issue?
  • placements are a key part of the programme
  • discrepancy between theory and practice outcomes
  • potential consequences:
    • patients
    • students
    • colleagues
    • profession
  • assessment is a shared responsibility between higher education establishment and service.

What constitutes poor performance?

Agree/disagree ÂÌñ»»ÆÞ“ would you fail a student for issues with:
  • safety
  • lack of knowledge
  • clinical reasoning
  • unprofessional behaviour
  • poor risk awareness
  • poor attitude
  • personality issues
  • trustworthiness
  • poor skills
  • lack of insight.
Which aspects are most challenging to assess?
  • clinical reasoning
  • unprofessional behaviour
  • poor risk awareness
  • poor attitude
  • personality issues
  • trustworthiness
  • lack of insight.
These are less tangible but all need addressing.
Some behaviours that can alert you to the need to take action such as:
  • inconsistency in clinical performance
  • not responding appropriately to constructive feedback
  • appears unable to make changes in response to constructive
  • has limited interactions or poor communication skills
  • experience continual poor health; feels depressed, angry, uncommitted, withdrawn; is emotionally unstable, tired or listless.
Can you identify other behaviours you have encountered that indicated a need to offer further support/involve others?
Challenges of dealing with poor performance:
  • accurate and timely identification of issues
  • managing the process
  • dealing with the ÂÌñ»»ÆÞ˜fall outÂÌñ»»ÆÞ™
  • what happens next?

Identifying poor performance

Scanlan et al study: mentors took an average of two-three weeks to recognise a failing student.
Scanlan, J.M., Care, W.D., Gessler, S. (2001) Dealing with the unsafe student in clinical practice. Nurse Educator. Vol. 26 (1), pp.23-27.
Identified issues early on but:
  • gave ÂÌñ»»ÆÞ˜settling inÂÌñ»»ÆÞ™ time
  • hoped students would ÂÌñ»»ÆÞ˜pick up the signalsÂÌñ»»ÆÞ™
  • lack of a ÂÌñ»»ÆÞ˜concreteÂÌñ»»ÆÞ™ issue.
If the difficulty is related to a disability or learning impairment
You need to need to consider where to get additional support relating to the ÂÌñ»»ÆÞ˜Disability Discrimination ActÂÌñ»»ÆÞ™ (2005), and consider what reasonable adjustments are required.
However, many individuals are unaware that they have difficulties that may impact on healthcare practice. Mentors/PPE need to be aware that some traits, such as the following, could indicate dyslexia:
  • erratic spelling
  • misreading
  • poor handwriting
  • poor memory retention
  • difficulty in organising work
  • poor time management
  • short concentration span
  • confusion between right and left.
Source: RCN Toolkit

Managing the process

Support. Communication. Documentation. Action planning
Support
  • access early support
  • use of Placement Development Team and/or programme team
  • involve your team members in assessment process
  • gain or use advice from experienced educators.
Communication and documentation
  • clarity is key
  • use specific examples
  • be objective ÂÌñ»»ÆÞ“ constructively criticise the behaviour not the individual
  • use of safety/professional behaviour warnings
  • include copies of all documentation with final assessment
  • signatures of all involved.
Action planning
  • often useful to have tripartite meeting with student personal tutor/PDT and mentor/PPE
  • set SMART goals and review dates
  • may need to facilitate studentÂÌñ»»ÆÞ™s action planning and reflection
  • regular (but not incessant!) feedback.
Writing the formal assessment ÂÌñ»»ÆÞ“ issues:
  • mismatch between text and marks (if grading required)
  • need to give overall picture of progression: mid-way assessment to final assessment.

Failing to fail

Consider what would be the key challenges for you in failing a student?
Failing to fail ÂÌñ»»ÆÞ“ reasons:
  • leaving it too late
  • awareness of the consequences
  • personal challenges
  • experience and confidence.
Borderline assessments:
  • make sure the result matches the overall performance
  • be clear in your feedback - issues and development needs
  • document concerns in the assessment (and highlight to PDT/programme link that they are there).
Retrieval and Transfer of a Critical Care Patient within Special Situations (Level 7) Hero Image

Dealing with the fall-out and what happens next?

  • will need extra support to manage a poor performing student on placement
  • de-briefing is crucial
  • action planning-developmental needs, learning from process, official processes, student progression etc.
  • planning for future placements.